Political Factors and Enforcement of the Nursing Home Regulatory Regime

Article excerpt

  I. INTRODUCTION AND PURPOSE OF STUDY
 II. THE NURSING HOME REGULATORY REGIME
III. THENURSING HOME INSPECTION SYSTEM
IV. THE ROLE OF PUBLIC ADMINISTRATORS IN THE
     POLICYMAKING PROCESS
  V. POTENTIALLY INFLUENTIAL FACTORS
     A. Political Factors
        1. Survey of Previous Scholarship
        2. Definition and Operationalization of Key Terms
        3. Theses and Underlying Assumptions, and
           Results
     B. Oversight
     C. Affiliation or Ownership Status of Nursing Homes
        1. Survey of Previous Scholarship
        2. Definition and Operationalization of Key Terms
        3. Theses and Underlying Assumptions, and
           Results
VI. CONCLUSION

I. INTRODUCTION AND PURPOSE OF STUDY

Nursing homes are special facilities that provide round-the-clock medical care to persons who, due to old age or disability, have difficulties in navigating activities of daily living ("ADL"), such as bathing, dressing, eating, and using the toilet. (1) For these and related ADL tasks, nursing home residents receive help that is provided by a phalanx of caregivers, including nurses, physical therapists, occupational therapists, and social workers. (2) Nursing homes are a common technique for delivering long-term care (i.e., services and supports to meet health and personal care needs over an extended period of time) in the U.S. and other industrialized countries. (3) In the U.S., the history of these facilities dates back to the beginning of the twentieth century when, bereft of national government (4) assistance for the care of elderly or disabled persons, many states relegated these destitute individuals to decrepit almshouses and poor farms. (5)

Nursing home residents are individuals "who are not sick enough to need hospital care but are not able to remain at home." (6) These residents include the elderly (usually individuals 65 years and above) and younger adults with physical or mental disabilities. (7) Nearly two-thirds of nursing home residents are females; the remaining one-third are males. (8) As the nation's population grays, (9) more and more Americans are living in nursing homes. (10) According to the Government Accountability Office ("GAO"), in 2009, more than 1.5 million people resided in the nation's estimated 16,000 nursing homes. (11) The GAO is an arm of Congress, created under the Budget and Accounting Act of 1921, that has conducted numerous studies on nursing homes. Dubbed "the investigative arm of Congress," and "congressional watchdog," the agency supports Congress in meeting its constitutional obligations as well as helps improve the performance and ensure the accountability of the federal government through various means that include oversight of federal programs. (12) In the language of its infomercial, the agency "keep[s] a close eye on virtually every federal program, activity, and function," and, "[i]ts highly trained evaluators examine everything from missiles to medicine, from aviation safety to food safety, from national security to social security." (13) Formerly known as the General Accounting Office, the GAO changed its name (while making sure to retain the same acronym) to its present name in July 2004. (14) The GAO figure above does not include other persons who use these facilities. According to the Centers for Medicare and Medicaid Services ("CMMS"), another organization, like the GAO, versed in this topic, (15) in 2006, about 2.8 million patients stayed in a nursing home (the number includes both long-term and short-term residents after hospitalization). (16) This trend is expected to increase, beginning in 2011, when the first set of "baby boomers," (17) persons born in 1946, turns 65 years and becomes senior citizens. It is projected that, based on current trends, by 2030, an estimated 5 million people will need nursing home care, and that by 2020, nursing homes will need an estimated 66% more nurses. (18) Nursing home care costs account for about 6% of the nation's overall healthcare spending; (19) in 2006 total government spending for nursing homes reached a high of $125 billion. …